LASIK LASER

14 must know facts before having Lasik laser procedure ( refractive surgery) for myopia.

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People often opt to have the Lasik laser procedure without knowing what exactly it is and why should they to have it. These are 14 important facts , you must know before having Lasik laser procedure for myopia .

1 : What exactly is LASIK LASER procedure?

It’s a surgical procedure involving eye which is done to enable a person to see without glasses if he/she can see with the help of glasses before the procedure. It’s often done for myopia. Its neither the cure for myopia nor it prevent progression of myopia. Details of the procedure are shown in video below.

Credit : Monkeysee

: What is the usual outcome of the Lasik laser procedure?

Ability to see clearly without requiring thick spectacles.

Scientific studies have proven that majority of patients (91-98%) have satisfactory improvement in vision without glasses, quality of vision and overall quality of life. after Lasik laser procedure.

“Ability to see clearly without requiring thick spectacles “ does NOT mean that the procedure is absolutely trouble free. A small percentage of patients might have few issues like …

Need for glasses after the Lasik laser

 

  • Small amount of refractive error may be left behind which may require spectacles of small power.
  • After forty years of age , person will need glasses for near.

 

Post operative complications

 

  • Few patient may have glares or halos after surgery, which may persist for longer time.
  • Dryness in eyes.
  • Sight threatening complications are rare not impossible.

Glasses and looks

Researchers are really divided on the fact whether glass really affect the self esteem of the person. Most of the studies done in west show that it actually gives an intelligent and gentle looks to a person. Adolescent are more sensitive to the looks may have some issues with self-esteem, but then glasses removal surgery is not done in adolescent patients. Glasses removal surgery is done after progression of myopia has stopped which is often after 21 and sometimes unto 26. By this age, presence or absence of glasses hardly make any difference to the self-esteem or global self-worth or the person.

  • Uncomfortable with glasses of contact lens use. (4/5)
  • Cosmetically concerned (1/5)

In conservative societies like India, glasses are generally associated with physical weakness and often seen as negative attribute for matrimonial prospects. This can explained with the larger frequency of girls getting closure to marriageable age, opting for these.

5 : Are you really aware of the actual cost of the surgery?

 

Most of the patient opting for these procedures do not have the details of procedure and the possibility of the complications to actually take an informed decision. The scientific data available on internet to actually frame an opinion regarding the procedure safety is scientifically too complex for a lay man. Plus it is extremely difficult for the patient to get an the details of machine, technology and its safety record.

6 :Is Lasik laser covered under health insurance? 

No insurance

Lasik laser and refractive surgeries are considered cosmetic and are not covered by insurance anywhere in the world. Myopia is not considered as risk if it is less than 6 D. In India, some insurance companies provide cover in patients with myopia of more than -6 TO -7 D. The cover is for treatment of complications resulting from myopia like cataract, retinal detachment etc. Lasik surgery in not treatment of myopia. It is considered as cosmetic surgery as it simply removes the need of glasses to used by patients. So whether companies provide cover for Lasik laser for cases more than -7 D is to be confirmed by the insurance company only.

: Are you a suitable candidate for Lasik laser surgery?

It is not advisable before 18 years of age. That does not mean, you can have it, if you are more than 18 years. All the conditions given below should also be met.

Progression of myopia (glasses number increase) should have stopped.

  •  It should  not increasing for at least one year. If not so, some glass number will come after the surgery.

Central corneal thickness is more than 500 micron.

 

Procedure involve some thinning of the central cornea. If the cornea is already thin, further thinning will cause weakening of cornea, and associated long term complications.

Your glasses number is within the appropriate range

 

  1. Myopia -1 to – 8 D ( depending on technology/machine)
  2. Hypermetropia +1 to 6 D
  3. Astigmatism +1 to 6 D

You are free from associated eye or systemic diseases

Dry eyes, corneal disorder, Keratoconus, Amblyopia, autoimmune disease etc.

Lasik laser is not advisable in pregnancy

You have realistic expectation. 

Its a surgical procedures, and the outcome is not always predictable. Under correction and over correction is possible in of the some patients. Complications, however few, are associated with every procedure, including Lasik laser.

EIGHT : What are complications after complications of Lasik laser ?

Dry eyes

Dry eyes is a common problem after Lasik laser but it  is temporary. patients aye relieved by artificial tear supplements.

Inadequate correction

Inadequate correction of refractive error. Glasses number is not completely removed and patient might need glasses of a smaller number.

 

Difficulty in night driving

Glare, Halos, difficulty in night driving are possible in few patients.

9 : Are complications common after complications of Lasik laser?

No, except for dry eyes, which is often temporary.

10 : What is Long term safety record of patients having Lasik laser ?

Eye infections ( keratitis)

There are lower risk of eye infections ( keratitis) in people having Lasik laser as compare to the those using contact lens.

Dry eyes

Dry eyes is a known long term complication associated with the Lasik laser procedure.

Cost of the surgery

Often the rates of the procedure are comparable among the different center, larger center have slightly higher price. Price should never be the deciding factor in this procedure.

11 : Is LASIK (laser eye surgery) a repeatable operation?

 

It can be repeated  under certain conditions but like any other surgery, it’s the surgeon’s decision to advise its indication and appropriateness. Usually it’s not.

12 : How to find the best LASIK surgeons/hospital in India.

 Doctor / hospitals

 

Cost of the surgery.

Often the rates of the procedure are comparable among the different centre, larger centre have slightly higher price ( 40-60K). Price should never be the deciding factor in this procedure.

13 : Which is the best technology for Lasik laser?

All the available machines/technologies have FDA approval. Recent scientific studies have failed to establish superiority on one technology on others in terms of overall outcome and patient safety after different type of Lasik procedures. Quite like mobile phones, newer technologies and machines keep coming in the market and are often promoted as most advanced or the best. All new machines have some advantages over the previous ones and have different set of complications associated with them. Femto-Lasik , Z-Lasik, wave front Lasik, Custom LASIK, Epi-LASIK , Contoura Vision, are few of the technologies/machine currently available.

14 : Is Lasix laser a safe procedure for sports personals?

There are high risk of complications in the patients engaging in contact sports like boxing , wrestling,  karate etc. If possible the Lasik procedure should be avoided.

 

CONCLUSION:

  1. LASIK LASER is a surgical procedure done on eye (cornea) to remove the requirement of  the spectacles to see clearly. It neither cures myopia nor reduces its progression.
  2. It is very safe procedure, Suitable candidate as patient and in the hands of a experienced surgeon.
  3. Cost varies from 40 K TO 100 K ( for both eyes) , and should not be deciding factor.
  4. Local ophthalmologist is best person to ask for the right Lasik laser surgeon in your city.
  5. INSURANCE COVER : NO
  6. Long term complications are few but not Zero.
    1. Sight threatening complications are rare but possible.
  7. Expectations should be realistic as it’s a surgical procedure

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Medical practice

Myopia: What can we learn from the experience of developed World?

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Changing the glasses is not enough . Newer research shows that we can slow the myopia progression rather than being the mute spectators.

Your son is having difficulty in seeing the blackboard and is taken to the doctor. He says your son needs  glasses. Sorry, your son has myopia. He comes back with spectacles on his nose and you with the guilt of what went wrong on your part that he got this disease.

The story remains the same, only the character and the locations are different when it plays out in any part of the world. The only good news (if it can actually be called one) is that if you are living in India, your children are slightly lucky as the prevalence of the myopia here is less than what we have in south East Asia, and Europe, US and Canada. Better statement would be to say we do not have the correct data for Indian population to actually compare. What we do have is the advantage of knowing what is going on there and to an extant why is it happening and if possible learn a lesson or two.

why do we have myopia ?

A recent report from Canada says that nearly 30 per cent of their population is myopic. Not only the are rates  rising but it’s appearing in younger children. In a  study, reported from UK , scientist have we found a strong evidence that more your child time spend  in reading books , more is he/she at risk of developing  myopia. It also said that early start of schooling increases the length of time over which myopia can become severe. The researcher have reported an association between the amount of time a child spends outside playing, with  their likelihood of developing myopia. They could not explain why is this happening  but there are some evidence that sunlight itself has a beneficial effect on the eye and that the child effort to focus on a variety of objects near and far is also helpful in preventing myopia.

Genes

genetic study, from New York , done  160,420 individuals of European or Asian ancestry,  to study the role of genes in causing myopia. It  says that the  environmental and lifestyle factors have a role in myopia, but there is also evidence that genetic factors  also play their role . The researcher have attempted to look for potential genetic factors in individuals from European populations and from a population in East Asia, where myopia is particularly common. Authors reported “Our genetic observations add credence to the current notion that refractive errors are caused by a retina-to-sclera signaling cascade that induces scleral remodeling in response to light stimuli,”. That means that the pattern of light eye receives while   reading books or computer screen induces certain changes in the eye structure that results in myopia. Authors further added that their study   “provides a large number of new molecular candidates for this cascade and clearly implicates a wide range of neuronal cell types in the retina, the [retinal pigment epithelium], the vascular endothelium, and components of the extracellular matrix.”

 

Schooling

We all are aware of the public perception that people who wear glasses are usually studious. The recent reports say that this  is not entirely unfounded.A study published in BMJ says  that more time the children  spent in education, is a causal risk factor to develop  myopia. Importantly, it also adds that more years in education one has, more  likely one has the risk of  having myopia.  Myopic children have problem in doing the kind of jobs which require better distance vision like driving and outdoor games, but have better near vision so it actually gives them an educational advantage.

Problem of myopia in china and south east Asia is more concerning, making it an important public health issue. Shanghai’s Health and Family Planning Commission report from China says that 47.2 percent of primary school students, 75.8 percent of middle school students and 89.3 percent of high school students suffer from myopia. The number of those affected grows as children get older. It is the lack of outdoor activity, a very  strong  pressure from family for academic achievements  and  widespread long duration use of mobile screen  are  the major reasons cited for why the incidence of myopia is so high in China.

Studies also report that children which spend less time in outdoor activities like playing consistently reports higher incidence of myopia . This difference is noticed in the incidence of myopia reported from countries like china and Singapore where the incidence of myopia is high as compared to countries like  Australia or the United States .  Children from developed East and South-East Asian countries are found to spend less time outdoor than their counterparts in Australia or US. So there is enough scientific evidence to suggest that time spent outdoors during childhood protects against the  develoment of myopia. 

Others scientists have  correlated lower  light exposure with high  myopia risk, and it is possible that those who spend more years in education spending most of their time indoor have had less exposure to natural light. The progression of myopia is also reported to be faster in winter months, which further gives credence to this theory. Later is also the reason why countries like China and Singapore have started the concept of  “bright light classrooms” which is supposed to  protect against myopia . To what extent this strategy is useful will be seen later. With the available evidence, what can be best recommended is for children to spend more time outside.

What nations are doing about it  ?

The pace with which the prevalence of the myopia is increasing, is  definitely alarming. Though the complain of blurred vision is redressed with the wearing of glasses, it is neither the cure of the disease, nor it stops its progression.

Awareness

In Australia , the health organisations have started awareness programmes to change the public perception, especially how it can be prevented and  its long term consequences. Australia has started observing Myopia Awareness Week,  from 14 – 18 May, and china observess 6 june as  national Sight Day.

In Australia , Brien Holden Vision Institute (BHVI) Academy. organizes Program, which is directed to educate the ophthalmic practitioners to  change the way they manage myopia It is a self paced  Program that gives participants the  opportunity to connect with global leaders in myopia control, through a live webinar. It helps the profession to make an essential shift in myopia management strategies.

Outdoor activity

In China , the government is making a data base of the status of myopia in children by ensuring the regular eye checkup.  Doctors argue that over two-hours of outdoor activity every day can drop the risk of development of myopia in children so the  time allotted for  of outdoor activity in schools is been prolonged. As the ambient light is supposed to play a role in development of myopia, the local government is renovating lighting to make their classrooms brighter.

Apps

As the unnecessary mobile and other similar device usage as also been implicated in the  development of myopia, a company named  AntzWorkz has launched an application named Plano at an event at Singapore in October 2017. The company claims that Plano is the world’s first parental health management app which will help parents and teachers   to constantly  monitor the use of these devices by children

Newer lens

There are also efforts to develope better spectacles for myopic children as these are something they have to use anyways. A team of researchers from the Hong Kong Polytechnic University (PolyU) has claimed to have developed a lens that may slow down the progress of myopia in children. It is a Defocus Incorporated Multiple Segments (DIMS) Spectacle Lens that is claimed to correct myopia and astigmatism.  The DIMS Spectacle Lenses has a central optical zone surrounded by multiple segments of constant myopic defocus, there by using a homeostatic mechanism known as emmetropization, whereby the eyeball adapts to receive focused images. Again the benefits of this new technology are to be seen in future.

Cornea cross-linking

Another new technology is in  development phase at Columbia University in New York that is not only non-invasive but also claim to correct the myopia permanently.  According to Columbia university, the critical component of this new technology is low-density plasma which ionizes water molecules within the cornea resulting  in  cross-links. Later will induces changes in the mechanical properties of the treated corneal tissue. If carefully tailored, it can induce the required refractive changes in the eye. It offers advantages over the conventional laser treatment as the latter is invasive techniques, and is known to be associated with corneal thinning and other complications.

Now the question is what we can learn from their experience ?

where do we Indians stand ?

The 2016 Annual States of Education Report (ASER) survey  in India shows that over 25% of children in grades I to VIII were absent from school on the day a team visited the school. It raises a bigger question whether  we should actually be worried about myopia, when it is difficult for the government to keep the children in the schools. I would argue that we should be worried about both the issue. The development of a registry which documents various health parameters of children (including myopia) and the regular health assessment should be government’s priority. Myopia can also be included in various health awareness programs organized by governmental and non-governmental organizations. Parents should be made aware of the adverse effects of excessive mobile phone use by children and lack of outdoor activities. Doctor should start prescribing the modern spectacle lens having potential to reduce the progression of myopia. Parents should appreciate that outdoor games are just as important for children as getting good marks in exams. The access of mobile devices and similar screen based devised, to the children should be seriously monitored.

Currently our  spending on education   stands at 3.4 percent of the GDP which low by standards of developed countries. we hope that this spending will go up in days to come.  All schools will have classrooms,  and hopefully bright light ones.

Indian children will show the myopia trends similar to what some of  south east Asian countries are showing. Share your views on how we should address this issue in comments below.

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Scientific studies report that most individuals (81%) say that they “learned something new” regarding their health, the last time they went online. The majority (80%) of people found the information through a search engine as reliable.

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